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		<h1 class="catchCopy">皮膚科診断，もう迷わない！“皮疹の分布”と“症状”からロジカルに診断を絞り込み！</h1>
		

		<h1 class="title">Dr. 鶴田のアルゴリズム皮膚科診断術<span class="version"></span></h1>
		<h2 class="subTitle">フローチャートで攻略！炎症性皮膚疾患の肉眼診断</h2>

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					編集：鶴田大輔（大阪公立大学大学院医学研究科皮膚病態学教授）
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				<ul class="property"><li class="disc">B5判・232頁・4色刷</li><li class="disc">ISBN&nbsp;978-4-8306-3481-9</li><li class="disc">2023年11月16日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">「赤い病変」を有する皮膚疾患－炎症性皮膚疾患の肉眼診断をフローチャートで攻略する，実践的テキスト．11パターンの“皮疹の分布”と3つの“症状（痒い？痛い？無症候？）”から論理的に診断を絞り込むアルゴリズムを提示し，多数の症例を用いて実臨床におけるその活用方法を解説した．経験豊富な皮膚科医が提案するアルゴリズム皮膚科診断術で，あなたもエキスパートに！トレーニング中の皮膚科医だけでなく，日常診療で皮膚疾患を扱う他領域の医師やメディカルスタッフにも臨床現場で手元に置いてすぐに役立つ一冊．</section><section class="preface">序　文<br><br>　人生において読んで感動した書籍がいくつかある．皮膚病理組織学領域においてはAckerman氏の “Histologic diagnosis of inflammatory skin diseases： A method by pattern analysis”，ダーモスコピー領域ではKittler氏の“Dermatoscopy：Pattern analysis of pigmented and non-pigmented lesions”がある．いずれも診断を「経験」や「勘」に頼らず，「アルゴリズム」を使用して論理的に行う試みである．一方で，皮膚肉眼診断でアルゴリズムを使用して診断する試みはどのくらい成功しているであろうか？ いくつかの成書ではアルゴリズムを用いた試みは確かに行われている．しかし，私の経験と勘で行ってきた方法とは幾分馴染まない．<br>　これまでに私は地域医療に携わる皮膚科以外の医師達に対して講演する機会が何度かあった．その折に，まず，「色」で皮膚病変を分類し，①痒い，②痛い，③何ともない（無症候性）のいずれに属するかで診断を狭めていく方法をお話ししてきた．もちろん色で言えば，皮膚病は「赤い病変」が多いことは自明である．本書は「赤い病変」を有する皮膚疾患，炎症性皮膚疾患のアルゴリズム診断に対する一つの提案である．<br>　日常診療で，私はまず，炎症性皮膚疾患か，腫瘍性皮膚疾患か，その他に大まかに分類し，次に，皮疹の分布を見る．最後にそれは痒いか，痛いか，何ともないか問診し，診断を狭めていることに気づいた．<br>　Ackerman氏の上述の書籍では，病理組織の弱拡大での炎症細胞の「分布」のパターンとその構成細胞から病理組織診断を行うという試みがなされている．論理的には今回の試みもこれに近いものがあると考えている．つまり，皮膚科医には馴染みのある方法である．<br>　「皮疹の分布」を11型にまとめ，そのうえで症状を3つにまとめて診断を狭めるという方法を今回提案した．<br>　おそらく他のもっと素晴らしい方法があるかもしれない．しかし，誰かが何かを提案しないと，肉眼診断分野も進まないであろう．一つの提案としての書籍をここに上梓する決意を私はもった．<br>いろいろな医師，メディカルスタッフ，他の領域の方々に広く読んでいただき，多くの批判をいただいて，次回より良い提案をするか，このままでよいか，はたまた私以外の適切な著者による進化<br>を求めるかは今のところわからない．しかしながら，トレーニングの不足している皮膚科医，勉強中の皮膚科医，皮膚疾患の診断を行わないといけない他の領域の医師やメディカルスタッフの方々<br>が暗中模索する状態から，一筋の光明を見出すことができたなら，本書の意味もあるであろう．<br>　皆様方のご意見をお待ちしたいと思う．<br>　それでは私の提案するアルゴリズムの世界にようこそ！<br><br>2023年9月<br>大阪公立大学大学院皮膚病態学教授<br>鶴田　大輔</section><section class="indexes">Ⅰ章　炎症性皮膚疾患の肉眼アルゴリズム診断の考え方 		<br>　　アルゴリズム全体図 	<br><br>Ⅱ章　分布の型から診断に迫る<br>　　本書で取り上げている疾患一覧		<br>　1．全身左右対称型 		<br>　　A　全身左右対称型で痒みがある 	<br>　　　症例1　アトピー性皮膚炎 <br>　　　症例2　丘疹紅皮症 <br>　　　症例3　DIHS <br>　　B　全身左右対称型で痛みがある 	<br>　　　症例4　GVHD <br>　　　症例5　尋常性天疱瘡 <br>　　　症例6　水　痘 <br>　　C　全身左右対称型で無症候性 	<br>　　　症例7　毛孔性紅色粃糠疹 <br>　　　症例8　PLEVA/PLC <br>　　　症例9　ジベルばら色粃糠疹 <br>　2．左右非対称限局型 		<br>　　A　左右非対称限局型で痒みがある 	<br>　　　症例1　慢性単純性苔癬 <br>　　　症例2　体部白癬 <br>　　　症例3　疥　癬 <br>　　B　左右非対称限局型で痛みがある 	<br>　　　症例4　固定薬疹 <br>　　　症例5　帯状疱疹 <br>　　　症例6　壊死性筋膜炎 <br>　　C　左右非対称限局型で無症候性 	<br>　　　症例7　扁平苔癬 <br>　　　症例8　線状苔癬 <br>　　　症例9　環状肉芽腫 <br>　3．頭部型 		<br>　　A　頭部型で痒みがある 	<br>　　　症例1　脂漏性皮膚炎 <br>　　　症例2　乾　癬 <br>　　　症例3　頭部白癬 <br>　　B　頭部型で痛みがある 	<br>　　　症例4　帯状疱疹 <br>　　　症例5　DLE <br>　　　症例6　限局性強皮症 <br>　4．顔面型 		<br>　　A　顔面型で痒みがある 	<br>　　　症例1　脂漏性皮膚炎 <br>　　　症例2　光線過敏症 <br>　　　症例3　酒さ様皮膚炎 <br>　　B　顔面型で痛みがある 	<br>　　　症例4　血管性浮腫 <br>　　　症例5　再発性多発軟骨炎 <br>　　　症例6　丹　毒 <br>　　C　顔面型で無症候性 	<br>　　　症例7　好酸球性膿疱性毛包炎 <br>　　　症例8　伝染性紅斑 <br>　　　症例9　顔面播種状粟粒性狼瘡 <br>　5．四肢体幹型 		<br>　　A　四肢体幹型で痒みがある 	<br>　　　症例1　貨幣状湿疹 <br>　　　症例2　水疱性類天疱瘡 <br>　　　症例3　マラセチア毛包炎 <br>　　B　四肢体幹型で痛みがある 	<br>　　　症例4　Sweet症候群 <br>　　　症例5　毛包炎，せつ，よう（せつ腫症） <br>　　　症例6　成人Still病 <br>　　C　四肢体幹型で無症候性 	<br>　　　症例7　モルフェア <br>　　　症例8　浮腫性硬化症 <br>　　　症例9　サルコイドーシス <br>　6．下腿足背限局型 		<br>　　A　下腿足背限局型で痒みがある 	<br>　　　症例1　好酸球性蜂窩織炎 <br>　　　症例2　先天性表皮水疱症（前脛骨部型） <br>　　B　下腿足背限局型で痛みがある 	<br>　　　症例3　IgA血管炎 <br>　　　症例4　リベド血管症 <br>　　　症例5　結節性紅斑 <br>　　C　下腿足背限局型で無症候性 	<br>　　　症例6　色素性紫斑 <br>　　　症例7　糖尿病性壊疽 <br>　7．手掌足底限局型 		<br>　　A　手掌足底限局型で痒みがある 	<br>　　　症例1　異汗性湿疹 <br>　　　症例2　手湿疹 <br>　　　症例3　足白癬 <br>　　B　手掌足底限局型で痛みがある 	<br>　　　症例4　手足症候群 <br>　　　症例5　肢端紅痛症 <br>　　　症例6　掌蹠角化症 <br>　　C　手掌足底限局型で無症候性 	<br>　　　症例7　掌蹠膿疱症 <br>　　　症例8　毛孔性紅色粃糠疹 <br>　　　症例9　梅　毒 <br>　8．手指足趾限局型 		<br>　　A　手指足趾限局型で痒みがある 	<br>　　　症例1　汗　疱 <br>　　　症例2　手白癬・足白癬 <br>　　B   手指足趾限局型で痛みがある 	<br>　　　症例3　凍　瘡 <br>　　　症例4　レイノー症候群 <br>　　　症例5　手足口病 <br>　9．関節伸側限局型 		<br>　　A　関節伸側限局型で痛みがある 	<br>　　　症例1　ガングリオン <br>　　　症例2　関節リウマチ <br>　　　症例3　滑液包炎 <br>　　B　関節伸側限局型で無症候性 	<br>　　　症例4　皮膚筋炎 <br>　　　症例5　強皮症 <br>　　　症例6　毛孔性紅色粃糠疹 <br>　10．間擦部型 		<br>　　A　間擦部型で痒みがある 	<br>　　　症例1　アトピー性皮膚炎 <br>　　　症例2　脂漏性皮膚炎 <br>　　　症例3　皮膚カンジダ症 <br>　　B　間擦部型で痛みがある 	<br>　　　症例4　慢性膿皮症 <br>　　C　間擦部型で無症候性 	<br>　　　症例5　角層下膿疱症 <br>　　　症例Hailey-Hailey病<br>　　　症例7　軟性線維腫 <br>　11．粘膜限局型 		<br>　　A　粘膜限局型で痛みがある 	<br>　　　症例1　ベーチェット病 <br>　　　症例2　尋常性天疱瘡 <br>　　　症例3　粘膜類天疱瘡 <br>　　B　粘膜限局型で無症候性 	<br>　　　症例4　梅　毒 <br><br>索　引</section></article>
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